Gastric ring for treatment of obesity

ABSTRACT

A gastric ring includes a band that surrounds the wall of the stomach of a patient, and structure that makes it possible, after implantation, to modify the cross section of the opening delimited by the ring. The ring includes a band including at least one deformable zone made of a material that is elastically deformable in the longitudinal direction of the band, where the deformable zone has at least two bearing points formed therein at respective locations separated in the longitudinal direction of the band, and at least one rigid element made of a bioabsorbable or biodegradable material and bearing against the deformable zone in the area of the bearing points, where the rigid element, before absorption, maintains the bearing points at a distance from one another different than the distance separating the two bearing points in the absence of elastic deformation of the deformable zone of the band, and, upon absorption, no longer forms an obstacle to the return of the deformable zone of the band to its nondeformed state.

The present invention concerns a gastric ring for treatment of obesity. Such a ring is also presently known as a “gastroplasty ring”.

It is known to treat a patient with pathological obesity by fitting a ring round the patient's stomach in such a way as to create, in the upper part of the stomach, a pouch of small dimensions, and an opening for flow of food, also of small dimensions.

The principle of such rings is well known, and the documents WO-A-86/04498 and EP-A-0 611 561 may be cited as documents illustrating existing gastric rings.

An existing gastric ring comprises an inflatable pouch situated on its inner face, making it possible to adjust the cross section of the opening delimited by the ring. This is because implantation of such a ring, which involves prior dissection, causes a greater or lesser degree of trauma to the stomach wall, and it is best not to immediately tighten this ring round this wall, so as to ensure that the latter can heal by scar formation.

The pouch is inflated by means of a fluid which is delivered percutaneously from an implantable chamber and by means of a conduit connecting this chamber to the pouch.

Some of the gastric rings according to the prior art have the disadvantage of being relatively aggressive with regard to the wall of the stomach, to the point of causing inflammation of this wall, or, in extreme cases, perforations of this wall. This aggressiveness is the result in particular of the pressure exerted by the inflatable pouch and of a lumen which is not perfectly continuous.

Moreover, said implantable chamber and said tube connecting this chamber and the pouch have the disadvantage of posing risks of leakage, migration and infection.

The chamber may be more or less visible beneath the skin, which is unfavorable from the esthetic point of view.

It is an object of the present invention to overcome all these disadvantages of the existing rings.

The ring to which the invention relates comprises in a manner known per se:

-   -   a band which is able to surround the wall of the stomach;     -   means for maintaining the band in the form of a ring able to         surround the stomach, and     -   means with which it is possible, after implantation, to modify         the cross section of the opening delimited by the ring.

According to the invention:

-   -   the band comprises at least one zone made of a material which is         elastically deformable in the longitudinal direction of this         band;     -   said zone has at least two bearing points formed on it at two         locations separated in the longitudinal direction of the band,         and     -   the ring comprises at least one rigid element made of a         bioabsorbable or biodegradable material and bearing against said         zone in the area of said bearing points, this rigid element,         before absorption, making it possible to maintain said bearing         points at a distance from one another different than the         distance separating these two bearing points in the absence of         elastic deformation of said zone of the band, and, after         absorption, no longer forming an obstacle to the return of said         zone of the band to its nondeformed state.

“Biodegradable” or “bioabsorbable” signifies the property by which a material degrades in vivo by a cellular, enzymatic or microbial mechanism (cf. for example degradation of collagen by collagenase) or by a physical-chemical mechanism (cf. for example hydrolysis of a lactic acid polymer).

Such a bioabsorbable material is preferably chosen from the group consisting of polymers of p-dioxanone, polyglycolides, polyorthoesters, polymers of trimethylene carbonate, stereocopolymers of L and D lactic acid, homopolymers of L lactic acid, copolymers of lactic acid and a compatible comonomer, such as alphahydroxy acid derivatives. Still more preferred, the bioabsorbable material has a polydispersity of less than 2.

By way of a preferred example, the biodegradable or bioabsorbable material is a lactic acid polymer (PLA) or polyglycolic acid polymer (PGA), or a copolymer of lactic acid or polyglycolic acid (PLA-PGA).

The ring according to the invention is placed round the stomach, after which the absorption of the element or elements made of bioabsorbable material which the ring comprises allows said deformable zone or zones of the band to recover their neutral form of nondeformation. The circumference of the ring, and thus the cross section of the opening delimited by this ring, can thus be adapted to the treatment needs of the patient.

This ring does not therefore comprise a pouch on its inner face, nor an implantable chamber and tube connecting this chamber to this pouch. The result of this is that the ring is largely nonaggressive with respect to the wall of the stomach and makes it possible to eliminate all the aforementioned disadvantages of using an inflatable pouch, implantable chamber and tube.

Each element made of bioabsorbable material is principally intended to maintain the zone of the band, along which it extends, in a stretched state; the ring can thus be put in place in a state of relative distension in order to permit cicatrization of the stomach wall, then, after absorption of its element or elements made of bioabsorbable material, undergo contraction as a result of the resilience of the material constituting said deformable zone.

The principles of the invention could however be applied inversely, in order to obtain a distension after absorption, in which case each element made of bioabsorbable material is intended to maintain the zone of the band, along which it extends, in a contracted state.

Preferably, the band forms, at one end, an eyelet delimiting a shoulder, and it has, at its other end, a tapered shape facilitating its insertion into the eyelet; this other end comprises at least one snap-fit catch intended to be snap-fitted into the eyelet and to cooperate with the shoulder in order to maintain the band in the form of a ring.

Said other end can comprise several successive catches, making it possible to close the band at several diameters adapted to the specific circumstances of the patient to be treated.

According to one possible embodiment of the invention:

-   -   each pair of bearing points is formed by two opposite zones of         an opening formed radially and through said deformable zone of         the band, this opening being of circular shape when the         deformable zone is in a nondeformed state, but being able to         assume an oblong shape when this deformable zone is stretched         longitudinally; and     -   each rigid element has an oblong tubular shape and is         dimensioned so as to be able to be introduced with force into         the aforementioned opening in order to confer on this opening a         corresponding oblong shape, this oblong shape producing a         correlated longitudinal stretching of said deformable zone.

Each insert can have a slightly flared shape and can be placed on said deformable zone in such a way that its end of greater cross section is disposed on the outside of the ring.

This slightly flared shape permits adaptation of the insert to the curvature of the ring and thus avoids any risk of this insert being expelled when the band is curved to form the ring.

According to another possible embodiment of the invention:

-   -   each pair of bearing points is formed by two holes formed in         said deformable zone of the band, and     -   each rigid element has a staple shape, that is to say comprises         a body having two stubs, these stubs being intended to be         received in said holes; the distance separating the stubs is         greater than the distance separating the two holes when said         zone is in the unstretched state, so that the portion of this         zone situated between these holes is stretched when these stubs         are engaged in these holes.

The body of each element according to this other embodiment can have a curved shape permitting adaptation of this element to the curvature of the ring.

According to yet another possible embodiment of the invention:

-   -   each pair of bearing points is formed by two shoulders delimited         by a portion with a cross section smaller than that of said         deformable zone, and     -   each rigid element has a tubular shape and is intended to be         engaged on this portion of smaller cross section, in such a way         as to bear against the shoulders, the length of this element         being greater than the distance separating said shoulders when         said deformable zone in is the unstretched state, in such a way         that, when the ends of the tubular element are placed against         these shoulders, said portion of smaller cross section is         stretched.

The element can have a curved shape corresponding to the curvature of the ring, again to permit adaptation of this element to the curvature of the ring.

The invention will be clearly understood from the following description in which reference is made to the attached diagrammatic drawing which shows, by way of nonlimiting examples, three possible embodiments of the gastric ring in question.

FIGS. 1, 3 and 4 are views of this ring according to these three embodiments, respectively, shown in a cross section passing through the median plane of the thickness of this ring, and

FIG. 2A is a partial view of the ring shown in FIG. 1, from the direction of the arrow A in FIG. 1; FIG. 2B is a partial view of one end of the band shown in FIG. 1, including several successive catches.

FIG. 5 is a further view of the ring, including a small plate that connects the stubs to one another.

To simplify matters, the elements or parts of elements found from one embodiment to another are designated by the same reference numbers.

FIG. 1 shows a gastric ring 1 used for treatment of pathological obesity of a patient and presently referred to as a “gastroplasty ring”.

The ring 1 comprises a band 2 which is able to surround the stomach wall, and three rigid inserts 3.

The band 2 is made of a material which is elastically deformable in the longitudinal direction of this band and is in particular made of silicone. At one end 2 a, it forms an eyelet 4 delimiting a shoulder 5. At its other end 2 b, it has a tapered shape facilitating its insertion into the eyelet 4 and comprises a snap-fit catch 6 intended to be snap-fitted into the eyelet 4 and to cooperate with the shoulder 5 in order to maintain the band 2 in the form of a ring. As shown in FIG. 2B, end 2 b can comprise several successive catches 6, making it possible to close the band 2 at several diameters adapted to the specific circumstances of the patient to be treated.

At its end 2 b, the band 2 has a zone 2 c in which three radial through-openings 7 are formed. Each opening 7 is circular when the band 2 is in a nondeformed state, but can assume an oblong shape when this zone 2 c is stretched longitudinally.

Each insert 3 is made of a bioabsorbable or biodegradable material such as a lactic acid polymer (PLA) or polyglycolic acid polymer (PGA), or a copolymer of lactic acid or polyglycolic acid (PLA-PGA). As is shown in FIG. 2, it has an oblong tubular shape and is dimensioned in such a way as to be able to be introduced with force into an opening 7. It thus confers on this opening 7 a corresponding oblong shape which produces a correlated longitudinal stretching of the zone 2 c.

To adapt to the curvature of the band 2 when the ends 2 a and 2 b are in engagement, the inserts 3 have a slightly flared shape, their ends of greater cross section being disposed on the outside of the ring 1.

In practice, the band 2 is introduced into the patient's body and placed round the stomach using a minimally invasive technique such as laparoscopy, after which the end 2 b is engaged through the eyelet 4 until the catch 6 (FIG. 1A) snap-fits behind the eyelet 4 and this catch 6 bears against the shoulder 5.

The respective locations of this catch 6 and of this shoulder 5 have been predetermined in such a way that the ring 1 thus formed has a relative distension in relation to the desired tightening of the stomach wall, so as to permit cicatrization of the stomach wall before exerting a tightening stress on this wall.

The thickness of the inserts 3 is calculated, as a function of the material used, to ensure mechanical rupture of these inserts 3 about one to two months after implantation, this rupture taking place under the combined effect of the absorption of the inserts 3 and the tension exerted by the band 2. The rupture of these inserts 3 allows the zone 2 c to recover its neutral, unstretched state.

The ring 1 then undergoes contraction resulting from the resilience of the material constituting said zone 2 c, which gives to the circumference of the ring 1, and thus to the cross section of the opening delimited by this ring 1, dimensions adapted to the treatment needs of the patient.

In the case of the ring 1 shown in FIG. 3, the zone 2 c comprises two holes 7 which receive the stubs 3 a of an inserted staple-shaped element 3. The distance separating the stubs 3 a is greater than the distance separating the two holes 7 when the zone 2 c is in the unstretched state, so that the portion of this zone 2 c situated between these holes 7 is stretched when these stubs 3 a are engaged in these holes 7.

The body 3 b of the element 3 which comprises the stubs 3 a has a curved shape permitting adaptation of this element 3 to the curvature of the ring 1.

In the case of the ring 1 shown in FIG. 4, the zone 2 c has a portion of smaller cross section forming two shoulders 7. A tubular element 3 is engaged on this portion of smaller cross section and bears against these shoulders 7. The length of the element 3 is greater than the distance separating the shoulders 7 when the zone 2 c is in the unstretched state, so that, when the ends of the element 3 are placed against the shoulders 7, said portion of smaller cross section is stretched.

Here too, the element 3 has a curved shape corresponding to the curvature of the ring 1.

This gastric ring 1 affords a decisive improvement to the prior art, given that it does not comprise an inflatable pouch on its inner face, nor an implantable chamber and tube connecting this chamber to this pouch. The result is that this ring is largely nonaggressive with respect to the wall of the stomach and eliminates all the disadvantages associated with the use of an inflatable pouch, implantable chamber and tube.

It goes without saying that the invention is not limited to the embodiment described above by way of example, and that on the contrary it encompasses all variant embodiments falling within the scope of protection defined by the attached claims. Thus, the ring can comprise several deformable zones 2 c; the band 2 can be of a monobloc structure, as shown, or can have, outside the zone or zones 2 c, a structure different than that of this zone or these zones 2 c; each element 3 is principally intended to maintain the corresponding zone 2 c in a stretched state, but each zone 2 c could be maintained in a contracted state by one or more of these elements 3 in order to obtain a distension of the ring after absorption of these elements 3; the element 3 can be in the form of a “staple” as shown in FIG. 3, but with stubs 3 a having a length such that they traverse said deformable zone 2 c and receive a small plate 10 engaged on them and connecting them to one another, this small plate 10 making it possible to distribute the forces exerted on these stubs 3 a; these stubs 3 a and this small plate 10 can be designed in such a way as to form an assembly, in particular by snap-fitting, between these stubs 3 a and this small plate 10; so as not to form an excessive thickness on the inner face of the ring, the holes of the deformable zone 2 c which are intended to receive said stubs 3 a can be formed substantially perpendicular to the zone 2 c, so as to be situated substantially parallel to the axis of the ring 1 after formation of the latter, such that the body 3 b connecting these stubs 3 a is situated on one axial side of the ring 1 and said small plate 10 on the other axial side of this ring 1. 

1. A gastric ring for treatment of obesity, comprising: a band wherein the band forms, at a first end, an eyelet delimiting a shoulder, and in that it has, at a second opposite end, a tapered shape facilitating insertion of the second end into the eyelet, this second end comprising at least one snap-fit catch intended to be snap-fitted into the eyelet and to cooperate with the shoulder in order to maintain the band in the form of a ring, the band adapted to surround the stomach of a patient, and having at least one deformable zone made of a material that is elastically deformable in the longitudinal direction of the band, the deformable zone having at least two bearing points formed therein at respective locations separated in the longitudinal direction of the band, and at least one rigid element made of bioabsorbable or biodegradable material and bearing against the deformable zone in the area of the bearing points, each rigid element, before absorption or degradation, maintaining two bearing points at a distance from one another different than the distance separating the two bearing points in the absence of elastic deformation of the deformable zone of the band, and, upon absorption or degradation, releasing the deformable zone of the band between the two bearing points so as to allow the deformable zone to return to the nondeformed state, wherein at least the deformable zone of the band is made of silicone.
 2. The gastric ring as claimed in claim 1, wherein each rigid element, prior to absorption or degradation, maintains the deformable zone of the band, along a direction in which the rigid element extends, in a stretched state.
 3. The gastric ring as claimed in claim 1, wherein each rigid element, prior to absorption or degradation, maintains the deformable zone of the band along a direction in which the rigid element extends, in a contracted state.
 4. The gastric ring as claimed in claim 1, wherein the second end of the band comprises several successive catches that selectively close the band at several diameters adapted to circumstances of the patient to be treated.
 5. The gastric ring as claimed in claim 1, wherein each pair of bearing points is formed by two opposite zones of an opening formed radially and through the deformable zone of the band, the opening having a circular shape when the deformable zone is in a nondeformed state, and is deformed in an oblong shape when the deformable zone is stretched longitudinally; and each rigid element has an oblong tubular shape that press-fits into the opening to deform the opening into an oblong shape, and stretch the deformable zone in the longitudinal direction of the band.
 6. The gastric ring as claimed in claim 5, wherein each rigid element has a slightly flared shape that is insertable in a respective opening of the deformable zone such that the end of greater cross section is disposed on the outside of the ring.
 7. The gastric ring as claimed in claim 1, wherein each pair of bearing points is formed by two holes formed in the deformable zone of the band, and each rigid element has a staple shape, including a body having two stubs, the stubs being received in the holes, the distance separating the stubs being greater than the distance separating the two holes when the deformable zone is in an unstretched state, so that the portion of the deformable zone situated between the holes is stretched when the stubs are engaged in the holes.
 8. The gastric ring as claimed in claim 7, wherein the body has a curved shape that adapts to the curvature of the ring.
 9. The gastric ring as claimed in claim 7, wherein the stubs and the small plate form an assembly, in which the stubs snap-fit into the small plate.
 10. The gastric ring as claimed in claim 1, wherein each pair of bearing points is formed by two shoulders delimited by a portion with a cross section smaller than that of the deformable zone, and each rigid element has a tubular shape engaged on the portion of smaller cross section, so as to bear against the shoulders, the length of the rigid element being greater than the distance separating the shoulders when the deformable zone is in the unstretched state, such that, when the ends of the tubular elements are bearing against the shoulders, the portion of smaller cross section is stretched in the direction of deformation of the band.
 11. The gastric ring as claimed in claim 10, wherein the rigid element has a curved shape corresponding to the curvature of the ring.
 12. The gastric ring as claimed in claim 1, wherein each rigid element is made of a lactic acid or polyglycolic acid polymer, or of a lactic acid or polyglycolic acid copolymer. 